The recently released 2021 European Society of Cardiology (ESC) guidelines on cardiovascular disease (CVD) prevention in clinical practice [[1] ] were developed to provide healthcare professionals with indications on how to optimize their efforts to reduce the burden of atherosclerosis cardiovascular disease (ASCVD). Compared with the latest version (2016), a number of new recommendations have been introduced, based on the availability of new treatments and the new goals indicated by the most recent ESC guidelines for the management of dyslipidaemias [[2]], hypertension [[3]], and diabetes [[4]].
The most relevant novelty in these guidelines is that the estimation of CVD risk is based on the application of new algorithms, i.e SCORE2 and SCORE-2-OP. SCORE2 has replaced the previous SCORE algorithm and has been developed to estimate 10-year fatal and non-fatal CVD risk in individuals in Europe without previous CVD or diabetes aged 40–69 years [[5]]. It provides estimates for the combined outcome of fatal and non-fatal CVD events, and it has been recalibrated using the most recent CVD rates available. As most of the 10-year CVD risk prediction models generally have a poor performance in older individuals, which can result in the overestimation of the risk and a consequent excess use of medication, an older person-specific risk score has been created to overcome these limitations. The SCORE2-OP, unlike the original SCORE-OP (which estimated the risk of fatal CVD), takes into account non-fatal CVD events (such as non-fatal stroke) that are clinically relevant in older persons [[6]]. Based on these algorithms, individuals having SCORE2 >7.5% for age under 50, SCORE2 >10% for age 50–69, and SCORE2-OP >15% for age >70 years are considered at very high CVD risk. The application of these two updated algorithms tailored on specific age groups may increase the identification of individuals at high risk of developing CVD, albeit an age-independent approach is definitely needed.